Pregnancy new ppt

PREGNANCY By: shenellD 7/4/2010 shenellD

Pregnancy Objectives: What happens to an egg after fertiliZation? How does a baby develop in the uterus? 7/4/2010 shenellD

Fertilization ,[object Object]

Fertilization occurs in the outer third of the fallopian tube – the ampullar portion.

other terms are conception, impregnation, or fecundation.

The critical time span during which fertilization may occur is about 72 hours.7/4/2010 shenellD

Steps in fertilization 7/4/2010 shenellD

1.Following ovulation, as the ovum is extruded from the graafian follicle, it is surrounded by a ring of mucopolysaccharide fluid (zonapellucida) and a circle of cells (corona radiata). These structures increase the bulk of the ovum, facilitating it’s migration to the uterus. 7/4/2010 shenellD

2. The ovum and surroundings cells are propelled, into the fallopian tube by the fimbriae, the fine, hair-like structures that line the openings of the fallopian tubes. 7/4/2010 shenellD

3. Only one ovum reaches maturity a month, a normal ejaculation of semen averages 2.5 ml of fluid containing 50 to 200 million spermatozoa per ml. or averages of 300-400 million per ejaculation. To promote the possibility of a sperm reaching the ovum, there is a reduction in the viscosity of cervical mucus at the time of ovulation. 7/4/2010 shenellD

4. Spermatozoa deposited in the vagina reaches the cervix of uterus within 90 seconds after deposition ant the outer end of the fallopian tube in 5 minutes. The functional life of spermatozoa is 48 hours. 7/4/2010 shenellD

5. Spermatozoa move by means of their flagella (tails) and uterine contraction through the cervix, the body of uterus toward the waiting ovum. All the spermatozoa that reaches the ovum cluster around the ovum’s protective layer of corona cells 7/4/2010 shenellD

6. Hyaluronidase(a proteolytic enzyme) is released by the spermatozoa which acts to dissolve the layer of cells protecting the ovum. 7/4/2010 shenellD

7. Only one spermatozoa is able to penetrate the cell membrane of the ovum. After it has done, cell membrane becomes impervious to other spermatozoa. 7/4/2010 shenellD

8. After penetration, the chromosomal material of the ovum and spermatozoa fuse and the structure is called zygote. Sperm (23) + Egg (23) = Fertilized Cell (46) 7/4/2010 shenellD

Is the contact between the growing structure and the uterine endometrium7/4/2010 shenellD

1. Once of fertilization is complete, the zygote migrate for 3 to 4 days to reach the body of uterus. This time mitotic cell division or cleavage begins. The first cleavage occurs at about 24 hours 7/4/2010 shenellD

2. As the zygote reaches the uterus it consists of 16 to 50 cells. Its bumpy outward appearance is termed morula (from Latin word morus meaning “mulberry.”) 7/4/2010 shenellD

3. The morula continues to multiply as it floats free in the uterine cavity for 3 or 4 more days. Large cells tend to mass at the periphery of the ball, leaving a fluid space surrounding an inner cell mass. The structure is now termed blastocyst. 7/4/2010 shenellD

4. The cells in the outer ring are known as trophoblast cells. They are the part of the structure that forms the placenta and membrane the inner cell called erythroblast cells is the portion that forms the embryo. 7/4/2010 shenellD

5. After the 4th day of free floating, the residues of corona and zonapellucida are shed by growing structure. The blastocyst brushes against the rich uterine endometrium a process termed apposition. It attaches to the surface of the endometrium (termed adhesion) and settles down into soft folds (invasion) 7/4/2010 shenellD

6. The blastocyst is able to invade the endometrium because as the trophoblast cells on the outside of blastocyst touch the endometrium, they produce proteolytic enzymes that dissolve the tissue they touch. This allows the structure to burrow into endometrium, receive some basic nourishment of glycogen and mucoprotein and establishes an effective communication network with the blood system of the endometrium. 7/4/2010 shenellD

Stage 1: Fertilization 1 day post-ovulation 1 Egg, 300 Million Sperm 0.1 - 0.15 mm Fertilization begins when a sperm penetrates an an egg and it ends with the creation of the zygote. Fertilization takes about 24 hours. 7/4/2010 shenellD

Stage 2: Division 1.5 - 3 days post-ovulation First Cell Division When cell division produces sixteen cells, the zygote becomes mulberry shaped. It leaves the fallopian tube and three to four days after fertilization 7/4/2010 shenellD

Stage 3: Implantation Begins 0.1 - 0.2 mm 4 days post-ovulation About four days after fertilization, the egg enters the uterine cavity. Cell division continues, forming a cavity in the center of the egg. Cells flatten and compact on the inside of the cavity. The entire structure is now called a blastocyst. 7/4/2010 shenellD

Stage 4: Implantation Begins 0.1 - 0.2 mm 5 - 6 days post-ovulation The blastocyst "hatches" around the sixth day The implantation site becomes swollen with new capillaries, and blood circulation begins 7/4/2010 shenellD

Stage 5: Implantation Completed 0.1 - 0.2 mm 7-12 days post-ovulation The inner cell mass divides, rapidly forming a two-layered disc. The top layer of cells will become the embryo and amniotic cavity, while the lower cells become the yolk sac. Placenta begins forming 7/4/2010 shenellD

Thank you!!! 7/4/2010 shenellD

From… Fertilization-The union of ovum and spermatozoa. zygote-chromosomal material of the ovum and spermatozoa fuse Implantation-the contact from the growing structure to the endometrium. 7/4/2010 shenellD

blastocysts A blastocysts is a ball like structure composed of an inner cell mass, called embryonic disc or erythroblasts. The outer layer is the throphoblasts that gives rise to the placenta, fetal membranes, umbilical cord, and amniotic fluid. 7/4/2010 shenellD

the embryonic disc gives rise to the three primary layers which are: Ectoderm- gives rise to the skin, hair, nails, sense organs, nervous system, mucous membrane of the mouth and anus. Mesoderm- kidney musculoskeletal system, reproductive system and cardiovascular system Entoderm-bladder,lining of the gastrointestinal tract, tonsils, thyroid gland, and respiratory system. 7/4/2010 shenellD

trophoblasts The important functions of the trophoblasts is to absorb nutrients from the endometrium and secrete hormone HCG or human chorionic gonadotropin, necessary in prolonging the life of the corpus luteum 7/4/2010 shenellD

Once implanted, the zygote is now an embryo. 7/4/2010 shenellD

Embryonic and fetal structures 7/4/2010 shenellD

The decidua Decidua- latin word means “falling off” After implantation, the endometrium is referred to as decidua, the specialized endometrium of pregnancy. It is composed of 3 layers: Deciduavera Deciduabasalis Daciduacapsularis 7/4/2010 shenellD

DeciduaBasalis part of the endometrium lying directly under the embryo and where trophoblast cells are establishing communication with maternal blood vessels. 7/4/2010 shenellD

DeciduaCapsularis Stretches or encapsulates the surfaces of the trophoblast 7/4/2010 shenellD

Decidua Vera the remaining portion of the uterine lining It fuses with deciduacapsularis when the gestational rings grows enough to occupy the entire uterine cavity. Like a blanket of the embryo At birth the entire surface of the uterus is stripped away, leaving the organ susceptible to hemorrhage and infection. 7/4/2010 shenellD

the chorionic villi Chorionic villi- miniature villi, or probing “fingers” that reach out from the single layer of cells into the uterine endometrium. Two distinct layers: Syncytiotrophoblast or syncytial layer Cytotrophoblast or langhans’ layer 7/4/2010 shenellD

Syncytiotrophoblast or Syncytial Layer outer layer responsible in the production of HCG, Somatomammotropin (human placental lactogen), estrogen and progesterone. 7/4/2010 shenellD

Cytotrophoblastor Langhan’s Layer Inner layer that protects the growing embryo and fetus from infections organisms such as spirochete of syphilis. 7/4/2010 shenellD

The chorionic villi in contact with deciduabasalis proliferate rapidly because they will receive rich blood supply from the uterus. Responsible for absorbing nutrients and oxygen from maternal blood stream and disposing fetal waste products including carbon dioxide. 7/4/2010 shenellD

The placenta Placenta- latin for pancake, because of the appearance. It covers about half of the surface area of the internal uterus. It serves as the fetal lungs, kidneys, and gastrointestinal tract and a separate endocrine gland throughout the pregnancy. 7/4/2010 shenellD

The placenta Arises out of trophoblast tissue. It contains 20 cotyledons and weighs 400-600 grams. The rate of uteroplacental blood flow in pregnancy increases about 50 ml/min at 10 weeks to 500 to 600 ml/min at term. It develops by the third month and formed by union of chorionic villi and deciduas basalis. 7/4/2010 shenellD

Placenta Consists of an embryonic portion and a maternal portion 7/4/2010 shenellD

placental Circulation ,[object Object]

waste diffuses into the maternal blood from the fetal blood7/4/2010 shenellD

What is the function of yolk sac? Yolk sac appears to supply the nourishment only until implantation. After which, its main purpose is to provide a source of red blood cells until the embryo’s hematopoetic system is mature enough to perform this function. So, circulation starts as early as 16th day of life and heart beat as early as the 24th day. 7/4/2010 shenellD

The umbilical cord Formed as chronic villi begins to function, initiating circulatory communication with the maternal blood pools joined together into larger veins and arteries; about 21 inches in length at term and 2cm in thickness Contains one vein and two arteries ( AVA) 7/4/2010 shenellD

Functions The bulk of the cord is a gelatinous mucopolysaccharide called Wharton’s jelly which gives the cord body and protects therein and arteries from pressure To transport oxygen and nutrients to the fetus from the placenta. Smooth muscle is abundant in the arteries of the cord and the construction of these muscles after birth contributes to homeostasis and helps prevent hemorrhage of the newborn. 7/4/2010 shenellD

Fetal membranes ,[object Object],7/4/2010 shenellD

Amniotic Fluid Amniotic Fluid – forms within the amniotic cavity and surrounds the embryo. Consist of 800 to 1200 ml of fluid at the end of pregnancy; contains fetal urine, lanugo from fetal skin, epithelial cells and subaqueous materials. pH – 7.2; specific gravity – 1.005 – 1.025 7/4/2010 shenellD

Functions: Provides a cushion against injury Protects the fetus from changes in temperature Protects the umbilical cord from pressure, protecting fetal oxygenation Aids muscular development Excretion collection system The fetus drinks the fluid 7/4/2010 shenellD

TERMS TO DENOTE FETAL GROWTH 7/4/2010 shenellD

Care of the pregnant woman Physiologic change of pregnancy 7/4/2010 shenellD

Local change Face – Chloasma – darkening patches of the face due to melanocyte stimulating hormone. “Mask of Pregnancy” 7/4/2010 shenellD

Breast – the areola darkens in color and diameter increase from 3.5 to 5 cm; formation of secondary areola. blue veins become prominent and the sebaceous glands of areola (Montgomery’s tubercles) enlarge and become protuberant by the 16 week- colostrums, a thin, watery, high protein fluid may be expelled from the nipples 7/4/2010 shenellD

Abdomen Diastasis; due to overstretching of tissue to accommodate growing fetus and separation of rectus muscles. Bluish groove at the site of separation. Linea Nigra: a brown line running from the umbilicus to the symphysis pubis StriaeGravidarum: pink or reddish streaks on the sides of eh abdomen wall and on thigh due to rupture and atrophy of small segment of connective layer of the skin. Spider hemangiomas. 7/4/2010 shenellD

Vagina – Chadwick’s sign – purplish discoloration Leukorrhea– thick whitish vaginal discharge without signs of itching. 7/4/2010 shenellD

Cervix –Goodell’s sign – softening of the cervix - formation of mucus plug (operculum) to seal out bacteria 7/4/2010 shenellD

Uterus -Hegar’s sign – softening of lower uterine segment Braxton Hick’s Contractions: occurs through out pregnancy Amenorrhea Ballottement: during the 16th to 20th week of pregnancy, a sudden push of the fetus 7/4/2010 shenellD

Bi-manual pelvic exam to palpate uterus 7/4/2010 shenellD

Signs and Symptoms of Pregnancy 7/4/2010 shenellD

Presumptive Signs – largely subjective that are experienced by the woman but cannot be documented by the examiner least indicative of pregnancy 7/4/2010 shenellD

A - amenorrhea B - breast changes C - color changes S-striaegravidarum M-melasma L-lineanigra F- fatigue, nausea, vomiting U- urinary frequency, uterine enlargement, leukorrhea Q- quickening 7/4/2010 shenellD

Probable signs –(objective) Can be documented by the examiner but not considered positive diagnostic indings. 7/4/2010 shenellD

(+) positive pregnancy test H - Hegar’s sign C - Chadwick’s sign G - Goodell’s sign B - ballotement F - Fetal parts as felt by the examiner 7/4/2010 shenellD

Positive Signs – signs that confirm pregnancy Fetal Heart sounds (16th week) Fetal Movements felt by the examiner Fetal Movement on Sonogram Fetal Outline (UTZ) 7/4/2010 shenellD

Systemic Change during pregnancy 7/4/2010 shenellD

Cardiovascular System: Heart rate increase 10-15 beats/ minute. Blood pressure decrease slightly in the second trimester due to lowered peripheral resistance to circulation but rises in the third trimester. Cardiac output increase 20% -30% during first and second trimester to meet increase tissue demands 7/4/2010 shenellD

Supine hypotension Syndrome – the woman experience light-headedness, faintness and heart palpitation as the woman lies supine, the weight of uterus presses the vena cava, obstruction to the blood flow. 7/4/2010 shenellD

Pseudoanemia - as the plasma volume first increase, the concentration of hemoglobin and erythrocytes may decline – Increase in RBC creating Normal levels of RBC again (Inc. Iron Ferrous sulfate) S04. 7/4/2010 shenellD

*Women need iron supplement 300-400 ml blood loss from normal delivery 800-1000 ml blood loss from cesarean delivery 7/4/2010 shenellD

Respiratory System Diaphragm rises as much as 1inch; slight dyspnea may occur until lightening . Increased vital capacity, tidal volume, respiratory minute volume to supply maternal and fetal needs. 7/4/2010 shenellD

Digestive System Slowed gastrointestinal motility and digestion. Tooth loss due to demineralization Displacement of intestine and compression of stomach. HYPERPTYALISM – increase salivation formation – increase level of estrogen. 7/4/2010 shenellD

Common problems: 1. Morning Sickness – nausea and vomiting early in the morning. HCG and progesterone begin to rise. 2. Heartburn - Pyrosis- reflux of stomach content into esophagus due to displacement of the stomach. - decrease gastric motility; relieved by eating small meals frequently and not lying down immediately after eating, to help prevent reflux. 2. Pica - eating non-food substance. - abnormal craving for substance - The most common is craving for ice cube - Often accompanies iron deficiency anemia *Encourage to take iron supplements 7/4/2010 shenellD

3. Constipation - because of reduced activity with GIT and pressure of growing fetus, and placental hormone relaxing contribute to decreased gastric motility. 4. Flatulence 5. Bleeding gums 7/4/2010 shenellD

Urinary System Increased urinary frequency on the first and third trimester because of pressure on bladder Glomerular filtration rate increased 50% 7/4/2010 shenellD

Glycosuria - because of increased excretion of sugar by lowered renal threshold. - presence of sugar in the urine. Lower specific gravity – a result of increased urinary output Polyuria –increase urine output – additional sodium and therefore additional water. 7/4/2010 shenellD

Endocrine System Thyroid activity in increased HCG reaches a peak in the third month Secretions of oxytocin which stimulates uterine contractions coupled with the drop in progesterone brings about labor Uterine contractions increase in frequency and intensity culminating in fetal expulsion 7/4/2010 shenellD

Skeletal System Gradual softening of pelvic ligaments and joints to facilitate passage of the body Lordosis(forward curvature of the lumber spinal standing with the shoulders back and abdomen forward in order to change center of gravity and make ambulation easier. “The Pride of Pregnancy” 7/4/2010 shenellD

Discomforts of Pregnancy and its Management 7/4/2010 shenellD

Nausea and Vomiting Eat five or six small, frequent meals; in between meals, have crackers without fluid. Avoid foods high in carbohydrates, fried and greasy or strong odor. 7/4/2010 shenellD

Fatigue Take frequent rest periods during the day. A good resting position is a modified Sim’s position with top of the fetus on bed, not on the woman, and allows good circulation in the lower extremities 7/4/2010 shenellD

Frequency of Urination Kegel’s exercise (alternately contracting and relaxing perineal muscles) helps to strength urinary control and decrease the possibility of stress incontinence and strength of perineal muscles for delivery 7/4/2010 shenellD

Breast tenderness Encourage to wear a bra with a wide shoulder strap for support and to dress to avoid cold drafts. 7/4/2010 shenellD

Flatulence Maintain daily bowel movement; avoid gas-forming foods Heartburn Avoid fatty, fried and highly spiced foods; small frequent feedings; 7/4/2010 shenellD

Constipation Drink sufficient fluids; Eat fruits and foods high in fiber and roughage; Exercise moderately; Avoid using mineral oil. (It interferes with the absorption of fat – soluble vitamins needed for good fetal growth and material health. 7/4/2010 shenellD

Hemorrhoids Apply ointments, suppositories, warm compresses; Avoid constipation. Insomnia Prevent prolonged nap time, offer milk, encourage warm bath. 7/4/2010 shenellD

Backaches Rest and improve posture; use a firm mattres; Use a good abdominal support; wear comfortable shoes; Do exercises such as squatting, sitting, and pelvic rock. 7/4/2010 shenellD

Varicosities, legs and vulva Avoid long periods of standing or sitting with legs crossed. Sit or lie with feet and hips elevated. Move about while standing to improve circulation; Wear support hose; avoid tight garters. 7/4/2010 shenellD

Edema of legs and feet Elevate feet while standing or lying down; Avoid standing or sitting in one position for long periods. 7/4/2010 shenellD

Muscle cramps Extend cramped leg and flex ankles, pushing foot upward with toes pointed toward knee; Increased calcium intake elevating the lower extremities frequently during the day. 7/4/2010 shenellD

Dyspnea Sit up. Lie on back with arms extended above bed. Uses 2 or more pillows to sleep at night. 7/4/2010 shenellD

Supine Hypotensive Syndrome Change position to left side to relieve pressure of uterus on interior vena cava. 7/4/2010 shenellD

Leukorrhea (vaginal discharge) Practice proper cleansing an d hygiene; Avoid douche unless recommended by physician; A daily bath or shower to wash away secretions; Observe for signs of vaginal infection common in pregnancy. 7/4/2010 shenellD

NEED A BREAK? 7/4/2010 shenellD

PsychologicChanges of Pregnancy Maternal Adaptations to pregnancy 7/4/2010 shenellD

First Trimester: Initial ambivalence about pregnancy; pregnant woman places main focus upon self. Mother is self centered, baby is part of her. Grandparents are usually the first relatives to be told of pregnancy. ,[object Object],7/4/2010 shenellD

Second Trimester: Acceptance of reality of pregnancy; increased awareness and interesting fetus; introversion and feeling of well – being. Fantasizes about unborn child. ,[object Object],“I am going to have a baby.” 7/4/2010 shenellD

Third Trimester: Anticipation of labor and delivery and assuming mothering role, viewing infant as reality vs. fantasy; fears , fantasies and dreams about labor are common, “nesting” behaviors like preparing layette. ,[object Object],7/4/2010 shenellD

Paternal Reactions to Pregnancy 7/4/2010 shenellD

First Trimester: Ambivalence and anxiety about role change; concern or identification with wife’s discomfort (couvades) 7/4/2010 shenellD

Second Trimester: Increased confidence and interest in mother care; difficulty relating to fetus; jealousy. 7/4/2010 shenellD

Third Trimester Changing self-concept; concern about body change; active involvement common fears about delivery, mutilation, or death of partner or fetus. 7/4/2010 shenellD

Prenatal Period 7/4/2010 shenellD

Prenatal Visit Schedule of Visit if no complications: Every 4 weeks, up to 32 weeks Every 2 weeks from 32-36 weeks (more frequently if problems exist.0 Every week from 36-40 weeks 7/4/2010 shenellD

History Taking Assessment of Risk Factors: Age: Under 16 or 35 (greater risk over 40) Pregnant adolescence have a higher incidence of prematurity, pregnancy induced hypertension, cephalopelvic disproportion, poor nutrition and inadequate antepartal care. Women over 35 year old at risk for chromosomal disorder in infants, pregnancy – induced hypertension, and cesarean delivery; those over 35 years for first pregnancy may be at increased risk. 7/4/2010 shenellD

Terminology Gravidity #of current and completed pregnancies of any kind Parity # of completed pregnancies ≥ 20 weeks not delivered infants (e.g. twins) 7/4/2010 shenellD

Primigravida – a woman who is pregnant for the 1st child Primipara – a woman who had delivered, live born child; a woman who is pregnant for the first time. 7/4/2010 shenellD

Multigravida– a woman who has been pregnant previously. Multipara – a woman who has delivered 1 or more children previously Nulligravida– a woman who has never been pregnant. 7/4/2010 shenellD

Parity (TPAL) T= Number of Term Births P= Number of Premature births A= Number of Abortions L= Number of living children 7/4/2010 shenellD

G3/1-0-1-1: Terminology 7/4/2010 shenellD

G3/1-0-1-1: 3rd Pregnancy 1 Term delivery 0 Preterm deliveries 1 Abortion 1 Living child Terminology 7/4/2010 shenellD

G5/2-1-1-0: 5th Pregnancy 2 Term deliveries 1 Preterm delivery 1 Abortion 0 Living children Terminology 7/4/2010 shenellD

G2/0-2-0-3: 2nd Pregnancy 0 Term deliveries 2 Preterm deliveries 0 Abortions 2 Living children Terminology 7/4/2010 shenellD

Physical Assessment LEOPOLD’S MANUEVER a systematic method of observation and palpation to determine the presenting part, fetal position, presentation and engorgement. The woman should be in supine position with her knees flexed slightly. 7/4/2010 shenellD

1st Maneuver Palpate the superior surface of the fundus Facing the head part, palpate for fetal part found in the fundus Leopold_first.flv 7/4/2010 shenellD

2nd Maneuver Palpate the sides of uterus to determine where the fetal back is facing The left hand is left stationary on the left side of the uterus while the right hand palpates opposite side of the uterus from the top to bottom. Next, hold right hand stationary to immobilize the uterus, and palpate top to bottom on the left side Leopold_second.flv 7/4/2010 shenellD

3rd Maneuver Palpate to discover what is at the inlet of the pelvis. Grasp the lower portion of the abdomen just above the symphysis pubis between the thumb and index finger and try to press the thumb and finger together The presenting part is not engaged if the presenting part moves upward so an examiner’s hand can be pressed together. Leopold_third.flv 7/4/2010 shenellD

4th Maneuver Palpate to determine the fetal attitude Place fingers on both sides of the uterus 2 inches above inguinal ligaments. Press downward and inward The fingers of one hand will slide along the uterine contour and meet no obstruction; this is the fetal neck. The other hand will meet an obstruction and inch or so above the ligament, this is the fetal brow. Leopold_final.flv 7/4/2010 shenellD

Estimating Expected Date of Confinement (EDC) 7/4/2010 shenellD

Bartholomew’s Rule Estimate AOG: 3rd month(12 weeks)- fundus is slightly above symphisis pubis 5th month(20 weeks)- fundusia at level of umbilicus 8th month(32 weeks)- below the xyphoid process 9th month(36 weeks)- same level 7/4/2010 shenellD

Naegels’sRule Formula: 3 months + 7 days + 1 year Example Last Menstrual Period April 20 1995 - 3 mos+7 days+1 year January 271996 EDC: January 27, 1996 7/4/2010 shenellD

Example: solve the EDC LMP September 15, 2009 LMP July 20, 2006 LMP August 5, 2000 LMP April 16, 2014 LMP January 01, 2009 7/4/2010 shenellD

Mc Donald’s Formula Age of Gestation Formula: Fundicheight in cmx2/7 = AOG in months X 4 weeks = AOG in weeks Example: Fundic heights is 21 cm 21 cm x 2 = 42 /7=6 months x 4 weeks = 24 weeks fundal_height.flv 7/4/2010 shenellD

Example: solve for AOG Fundic height is 18 cm Fundic height is 24 cm Fundic height is 32 cm Fundic height is 16 cm Fundic height is 20 cm 7/4/2010 shenellD

Haase’sRuleFetal Length Formula: 1 to 5 months = months (squared) 6 to 10 months = months x 5 Examples 5 months = 5 mos. = 25 cm length 8 months = 8 mos. x 5 = 40 cm length 7/4/2010 shenellD

Example: solve for fetal length 6 mos. And 2 weeks 4 months 3 mos. And 3 weeks 8 mos. And 1 week 2 mos. And 2 weeks 7/4/2010 shenellD

Johnson’s Rule (grams) Fetal Weight Formula:Fundic Height (cm) – n x k N = 11 if part is not engaged 12 if part is engaged K = 155 grams (standard value) Example: Fundicheight = 21 cm not engaged 21 – 11 = 10 x 155 = 1, 550 grams 7/4/2010 shenellD

Example: solve for fetal weight FH is 24 cm engaged FH is 18 cm not engaged FH is 20 cm engaged FH is 16 cm not engaged FH is 22 cm engaged 7/4/2010 shenellD

NUTRITION DURING PREGNANCY Weight gain- variable,but 25 lbs usually appropriate for average woman with single pregnancy. Recommended weight gain during pregnancy: 2-4 lbs in the first trimester 11-14 lbs in the second trimester 8-11 lbs in the third trimester (0.5 lb weekly) 7/4/2010 shenellD

Weight gain in pregnancy occurs from the both growth of fetus and accumulation of maternal stores: Breast 1.5 –3 lbs Fetus 7 lbs Placenta 1.5 lbs Uterus 2.5 lbs Amniotic fluid 2 lbs Blood volume 3.5 lbs 7/4/2010 shenellD

NUTRITION DURING PREGNANCY B. Specific nutrition needs ,[object Object]

Protein: +30 g/day to ensure intake of 74-76 g/day

Iron: provide 100-200 mg/tab daily

Calcium: 1200 mg/day7/4/2010 shenellD

Sexual activity during pregnancy Basically sex is permitted on 2nd trimester as long as your comfortable and you don’t have complications. Avoid breast massage since it may stimulate early uterine contractions. Side by side or woman on top position. 7/4/2010 shenellD

Different Types of Exercise TAILOR SITTING It strengthens the thigh and stretches perineal muscles. The woman should not put one ankle on top of the other but should place one leg in front of the other gently push on her knees (pushing them toward the floor until she feels her perineum “stretch” 7/4/2010 shenellD

SQUATTING Helps to stretch the muscle of the pelvic floor. It should be done for 15 minutes day. The woman must keep her feet flat on the floor. 7/4/2010 shenellD

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